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Category: Dr. Gandhi’s Blog

February 17, 2016

Dr. Gandhi delivering babyWhat are some of your favorite parts about your job?
I really enjoy talking to my patients and caring for women. Especially as a woman. I feel like I can relate to a lot of the same worries and concerns they have.

Also, the spontaneity. This specialty incorporates surgical skills as well as quick-thinking on your feet. It is a moment-to-moment kind of thing, especially when it comes to delivering babies. I always feel totally humbled because when I get to work, my schedule may say one thing, but when I get done, I could have done a C-section at lunchtime or an emergency surgery that afternoon. All in the same day.

Dr. Gandhi graduation photoHave your studies and sub-specializing in FPMRS changed the way you think about patients or how you approach their problems?

The pelvis is such an interesting cavity, containing organs that play a crucial role in muscle support, reproduction and sexual function. After becoming board certified in this subspecialty, I realize that I play a unique role in helping women resolve issues of pelvic organ prolapse, leakage and sexual dysfunction. In fact, I realize how much women think about these embarrassing topics, especially the sexual dysfunction symptoms, and how much their needs change as they get older.

For both menopausal patients and younger patients, it’s becoming a lot more acceptable to talk about sexual dysfunction. There’s a cultural shift going on that is allowing and encouraging women to feel more comfortable talking to their doctors about it. I’ve learned how to talk to patients better about sex, too. And why they’re not enjoying it, and how to improve it. We even do ThermiVa in the office which is a procedure that helps tighten the vaginal canal and improves lubrication. This is cutting-edge technology that provides patients non-surgical options without having to even take hormones.

Another unique piece is the degree in which doctors are challenged to restore the anatomy without using synthetic materials (such as mesh). Patients are looking for surgical options that give them a quick recovery and yet, are successful. Surgical management of prolapse is more tailored to each patient, rather than using synthetic products to augment repair. I think I’m a better surgeon because of it.

What has been your biggest challenge?
I’m very sensitive. I really have to displace myself from taking things to heart. I worry about my patients all the time. How they’re doing; how I can help them. But it can be emotionally draining. I’m trying not to be such a worrywart all the time, and trying to be more objective.

What is your biggest success up until now?
Building up a medical practice that I am proud of – I can think of no other success than being a trusted provider. I think most of my referrals come from other patients. It’s been a slow process for me, but I see the difference in the number of patients after joining Cherokee Women’s eight years ago. I continue to grow and try to improve the care I deliver.

Patients have said to me, “I want to see you because I know you’ll take care of me.” It’s so flattering, it’s such a high. I can’t believe somebody would feel that way about me, especially if they don’t even know me. That’s what I wanted, when I was in medical school and residency, to have a situation where the patient could tell that their doctor loves what they do.

When you were young, how did you picture being a doctor? How is your work the same as that, and how is it different?Dr. Gandhi with mom photo
When you’re young, you don’t live in reality. You live in this foggy, idealistic world. I had a really good mentor, though. I went to high school in a very small town called Amanda, Ohio. Everybody kind of knew each other. My parents owned a grocery store, and we lived on top of the grocery store. I knew I wanted to go to medical school, and I surrounded myself with other people who believed in me and thought I could do it. I always pictured myself looking old (around 30 or so, because when you’re 15, 30 seems so old!), and saying, “Man, I knew I could do it.”

I realize now how naïve I was. The practice of medicine is on-going and fluid. One can never master it. But every great doctor aims high. This is what benefits patients in the long-run, a physician who never stops learning and is never “done.”

What words of wisdom would you give your younger self?

I think I would’ve told myself to have more fun. Trying to get everything done is an accomplishment, but sometimes it can compromise your ability to really grow as a person. If I could tell my fifteen-year-old self anything, I would say take moments to spend time with your family and friends. Every summer, all I did was study or go on some internship or work. And this is the first time in private practice that I’ve actually started taking vacations and making myself a priority.

My dad passed away in November and it’s really impacted my life and how I will live it in the future.

Dr. Gandhi with dad photoWho is one person who has had a tremendous impact on your life, personally or professionally? Why and how did this person impact your life?

Honestly, there is never just one person. My father obviously was my biggest supporter. He never doubted my ability and was so insistent that I could achieve ANYTHING as long as I worked hard. He and my mother and brother have been so crucial in getting me to this point. The sacrifices they made for me through the years, I could never repay. But I strive to make my father proud, every day. I miss talking to him during my lunch breaks. But I know he is with me. I am so lucky to have had HIM as my father, mentor and spiritual role model.

You’ve mentioned that you like Shakti Gawain’s quote, “Our bodies communicate to us clearly and specifically, if we are willing to listen to them.” What are some ways patients can be more in tune with their bodies? What kinds of things should they pay attention to?

I think one thing is to not ignore symptoms. Day to day, you want to think about what you’re putting into your body, and what your body is saying in return. If it’s time for an oil change in your car, and the little light in your dashboard comes on, you’ll probably get your oil changed. Symptoms are the dashboard warning lights. Our bodies communicate to us using these sometimes subtle signs or symptoms. We just have to make sure we heed the warning.

On the flip side, as a doctor, you’ve gotta pay attention too. The answers are there when the patient walks through the door. But they may not have the answers to explain what the patient is feeling. Most of the time, patients don’t want to complain about their symptoms. I ask them if they have any concerns or if they’re having any pain, and sometimes I get, “Not really.” Not really? Who knows what “not really” means in medicine? You have to really explore further.

Ideally, if patients are able to listen to their bodies, they shouldn’t prolong seeking care. A delay in getting care, whether financial, or for some other reason, can lead to disease or other issues that ultimately either require invasive intervention or make an issue untreatable.

November 2, 2015
Dr. Gandhi photo

Dr. Gandhi

Since the 2008 FDA Public Health Notification regarding use of transvaginal mesh for use in pelvic organ prolapse repair, there has been much controversy. Pelvic organ prolapse (POP) is a gynecologic condition that affects nearly a third of middle-aged women. POP is essentially weakness of the muscles that hold the pelvic organs in place, causing a bulge to be felt by the patient. I often describe it to patients as a sort of “vaginal hernia.” Symptoms include pelvic pressure, incontinence, and may affect sexual activity.  The reason why the use of synthetic mesh or biologic grafts came about is that in some women, their own tissue was not strong enough to uphold the repair.

Addressing Patient Concerns – Specialized Training Makes a Difference
I discuss with my patients both non-surgical and surgical options. When discussing the surgical options, I often hear patients say, “you are not going to use that ‘mesh’ in me, are you? I see it all over the TV, these lawyers say it’s dangerous.”

As a surgeon specializing in female pelvic medicine and reconstructive surgery (FPMRS), it is paramount that my communication includes a discussion of the indications, risks and potential benefits of any POP procedure. As FPMRS board certified physicians, Drs. Litrel, Haley and I have specialized training and education regarding POP repair with use of mesh. Pelvic floor surgeons trained in the use of these devices and that have properly counseled their patient on potential risks, have low complication rates. Patients need to know this important fact.

Individualized Treatment Plans Tailored To You
Individualized patient-centered  treatment plans are the key to limiting potential complications. When patients come for a consultation, there are three key elements to the visit: 1) discussion of the symptoms, 2) complete physical exam, and the 3) comprehensive treatment plan. Detailing the symptoms most distressing to the patient is important in tailoring a plan of care to meet her expectations. A complete physical exam helps to delineate the source of the pelvic floor weaknesses.  Lastly, the treatment plan should include not only the correct surgical procedure for the patient, but also an outline of how to avoid future recurrence of the prolapse. This includes discussing pursuing an overall healthy lifestyle (i.e. healthy diet, smoking cessation, routine exercise).

So the verdict?
I want patients to know that their specific prolapse needs can be met by a variety of surgical techniques, including mesh as one of them. When properly placed by a board certified urogynecologist and pelvic reconstructive surgeon, the complication rates are low. Empowering my patients with knowledge assures their eventual satisfaction with their final decision.

To schedule your GYN appointment or surgical consult, call 770.720.7733.

 

 

 

 

August 20, 2015

by Peahen Gandhi, MD, FACOG, FPMRS

Your Mission, Should You Choose to Accept It, Is To Recover ‘That’ Sensation.
As a gynecologist, my mission is to manage the entire spectrum of women’s health issues. Including…that, ummm, embarrassing topic of sexual functional concerns. Patients trust me enough to discuss even the most intimate of topics. It doesn’t hurt that I too, am a woman, able to understand both the physical and emotional elements of this sensitive subject.

In an abstract published by the International Continence Society, 48% of women reported concerns regarding “looseness of the vagina.” The medical term for this symptom is Vaginal Laxity Syndrome or “VLS.” Often women say to me, “things are different ‘down there.’ I mean, I think things are ‘loose.’ Is that why sex is not the same?”

Symptoms of Vaginal Laxity Syndrome
VLS most often occurs as a result of childbirth (in vaginal births), but also occurs as women age due to decreased levels of collagen. Almost 50 to 75% of women experience significant vaginal laxity after menopause due to a loss of estrogen’s protective effect on the vaginal muscles.

Symptoms of Vaginal Laxity Syndrome include:
• Decreased sensation during intercourse
• Difficulty holding urine
• Decreased resilience of the vaginal walls. (You can test this at home by trying this quick test: If you are able to insert three or more fingers simultaneously into your vagina without significant resistance of your vaginal walls, chances are you have a loose vagina.)

These symptoms lead to other difficulties, including difficulty achieving orgasm, as well as decreased sexual satisfaction. Many women are embarrassed or scared to discuss this issue with their partners.

Cherokee Women’s Offers Surgical and Non-Surgical Treatments
My physician colleagues and I at Cherokee Women’s Health are able to offer patients non-surgical and surgical options for VLS. We counsel patients first on the importance of leading a healthy lifestyle, such as maintaining a healthy weight, performing pelvic floor exercises like Kegels, and treating vaginal dryness or thinning in postmenopausal women. Once we learn more about your lifestyle and needs, we can recommend a treatment that works best for you.
Surgical and cosmetic procedures are available to restore the strength and resilience of vaginal tissue. They include vaginoplasty, perineoplasty, and labiaplasty. These vaginal rejuvenation procedures should be performed by board certified Female Pelvic Medicine and Reconstructive Surgery physicians (known as FPMRS). Those of us with the training and expertise to perform these procedures counsel patients on the potential risks and benefits. In fact, an article published in The Journal of Sexual Medicine from 2010 suggested that combining multiple female genital cosmetic surgeries improved the success rate up to 91.2% (even in severe cases).

Thermiva, a Less Invasive Alternative Treatment
A procedure called Thermiva offers women a less invasive alternative treatment for VLS. The Thermiva procedure increases sensitivity and strengthens muscular contractions, leading to greater sexual satisfaction for women and their partners. It is also effective in helping reduce vaginal dryness and urinary leakage episodes. The painless, in-office procedure takes twenty minutes to perform and yields immediate results. It works by inducing collagen tissue remodeling and rebuilding at a cellular level. Using radiofrequency thermal energy, Thermiva increases the number and strength of active collagen fibers that are present.

Knowing that there are a number of treatment options available is important because it allows doctors to individualize the care for each patient. Working together, doctors and patients are able to meet the expectations set forth, while reducing potential side effects or long-term complications. If you’re interested in discussing the Thermiva procedure with me or one of our other skilled physicians, please contact our office to schedule an appointment.

July 29, 2015

by Peahen Gandhi, MD, FACOG, FPMRS


Our approach to Female Pelvic Medicine and Reconstructive Surgery (FPMRS) is three-fold:

1) Restore Function
2) Enhance Appearance
3) Protect Anatomy

This is the treatment approach which guides our clinical procedural offerings. Gynecologists are experts in vulvovaginal surgery and CWHS is at the forefront of the latest techniques used to help patients achieve their pelvic health goals.

Thus, the procedures address these three facets:

1)  We Restore Function by addressing anterior and posterior compartment defects, like cystoceles and rectoceles, by offering anterior and posterior colporrhaphy, as well as full-length vaginoplasty, allowing improved sexual function as well. In addition, many patients have had severe obstetric lacerations, like third or fourth degree tears, and we perform revisions of proctoepisiotomies. Stress urinary incontinence is treated using a single-incision sling procedure.

2)  We Enhance Appearance by removing excess skin of the labia minora and labia majora through labiaplasty procedures, including a number of different techniques, so that we can achieve each patient’s individual cosmetic goals. In addition, we are experts at perineoplasty also called, perineorrhaphy, which aims to make the perineum appear normal by excising excess skin, loose skin tags, and suturing the underlying muscles of the perineal body closer, to give a more snug feeling in the introitus or vaginal opening. Some women are interested in fully restoring pre-coital appearance and we achieve this with an additional procedure called a hymenoplasty.

3)  We Protect Anatomy by offering our patients individualized non-surgical treatments like incision-less office based procedures for vaginal laxity and bioidentical hormone replacement therapy via vaginal and transdermal routes. Following surgery, patients are given nutritional support services through micronutrient testing (Spectrocell) and undergo pelvic physical therapy via our women’s allied health professionals.

Thus, a summary list of procedures:

*Full-length Vaginoplasty to provide a higher level of tightening
*Incision-less office treatment for improving vaginal tone and lubrication
*Labiaplasty
*Labia Majora reduction
*Perineoplasty
*Hymenoplasty
*Proctoepisiotomy revisions
*Anterior and posterior colporrhaphy to treat cystocele and rectoceles (site-specific and augmented repair techniques)
*Single-incision midurethral slings
*Bioidentical hormone replacement/nutritional support/pelvic physical therapy

NOTE: Dr. Peahen Gandhi and her colleagues Dr. Michael Litrel and Dr. James Haley are sub-specialty board certified in Female Pelvic Medicine and Reconstructive Surgery (FPMRS).

 

July 8, 2015

Get to know Dr. Peahen Gandhi, a board-certified OB/GYN physician here at Cherokee Women’s Health, on a more personal level. Read below to learn what inspired her to become a doctor and what she believes is important in life.

gandhi-spotlight-flyer_nletter

What inspired you to become a doctor?
“Of course there’s those heroic stories about Dr. Barnard performing the first successful heart transplant…but the source of my inspiration was more special. I had the example of ambition personified – my late Grandfather. Orphaned when he was just a young boy, he worked without pity on himself. He was engaged always in achievement, not fear of failure. I loved this about him. And I knew I was his favorite. I listened to his stories and he believed in my dreams. It was a symbiotic relationship. No doubts, no uncertainty ever entered our minds when we conversed. I learned from his experience and he inspired me to create my own. His sacrifice, allowing my parents and me to leave him in India and emigrate to the United States, was immense. Every summer when we went back to India after moving to Amanda, Ohio, he would have a “medical gift” for me. One summer it was a stethoscope, another it was a tuning fork. I still have the old copy of Gray’s Anatomy he found for me. I knew he cared. I knew he wanted to keep up the consistent encouragement. For that, I am indebted to him.

Who were your mentors along your medical journey?
“Well, having the calling to become a doctor is just the first step. Getting into the field is another story. You need an advocate who know the ins and outs. You need someone who will encourage you, when you think you can’t possibly make it. Chances seemed slim for a girl from the small town of Amanda, Ohio. Dr. Keith Krantz, the Director of the Hosier Scholarship Program, never saw me that way. To him, I was a real contender. I still remember when I got my first medical school acceptance letter and Dr. Krantz said to me “you got one in the bag, kiddo!” Dr. Krantz then awarded me the Dr. R. S. Hosler Memorial Educational Fund Scholarship. At the time, I think I was the only person from my high school who was awarded the honor. It not only gave me a sense of accomplishment, but the financial support of the scholarship allowed me to realize my dream of becoming a doctor. It has been four years since he passed, and even though I can no longer walk into his office and get my weekly pep-talk, I know he is giving me the “’ol kiddo” smile as I put on my white coat.

Do you have a philosophy about life or medicine?
Mahatma Gandhi said “Simple living, high thinking.” I think it’s important to spend time every day with the people you love. I keep my life simple, in that I focus on family when I’m home. My parents live with my husband and me, and we are surrounded with aunts, uncles, cousins, multiple generations, almost 30 people. We usually just get together at my house a few times a month and play cards and eat great Indian food! I think most people think I am an extrovert, but really I am kind of shy, unless I really know a person.

Fun Facts
~ Dr. Gandhi had a traditional Indian marriage in her father’s home village of Umreth in India. It lasted 10 days!
~ Dr. Gandhi believes in the strength of family: “Surrounding yourself with the people you love makes you a loving person.”
~ A family project – the restaurant Bello Italian in Cumming is owned by Dr. Gandhi’s brother, Paril.
Dr. Gandhi quips, “Most people think my brother has an Indian restaurant but I just laugh and say…actually it’s great rustic Italian food! I feel so fortunate to live in America, where anything is possible.”

 

 

 

October 15, 2014
Dr. Gandhi photo

Dr. Gandhi

It was so annoying. I could not sleep. Drip, drip, drip sang the faucet all night long. I created excuses for myself so I wouldn’t have to fix it. My excuses ranged from, “I don’t have time,” “I don’t have the money to spend on a plumber,” or the classic “it really isn’t that bad.” But every morning when I looked in the mirror, I realized I was suffering. I was sleep deprived and cranky.

Reluctantly, I went to the local home improvement store to get some advice.

“It’s probably the washer,” said the man behind the counter, while his thumbs snapped his suspenders. “Over time the washer is forced against the valve seat which causes it to wear out. As a result, you’ll notice dripping around the spout.” I thanked him kindly and proceeded to the cash register to make my purchase.

It made sense. It took just an hour to replace and voila! No more annoying drips.

You know what I realized from this experience? We women put up with a lot!

I see so many women come to my office with debilitating urinary leakage. They cannot enjoy Zumba for fear of an accident. Some cross their legs and hope for the best every time cold season comes around for fear that a sneeze will cause leakage. Others are embarrassed by leakage during intercourse.

So women endure the drip, drip, drip. They try to convince themselves that “they don’t have time to go to the doctor,” or they worry that “insurance won’t pay to fix it anyway” and of course, they tell themselves “it really isn’t that bad.”

Sound familiar? Of course it does. More than a third of women suffer from bladder control problems. The most common risk factor is childbirth. The muscles around the bladder and pelvis become weakened, which makes it harder for you to control when your urine starts flowing. Hormonal changes, such as diminished estrogen at the level of the urethra, also affect your ability to withstand increased pressure on your bladder such as exercise or even an unexpected sneeze.

Women are surprised when I counsel them on the treatment options available, most of which are lifestyle changes. However, surgical advances in the past ten years have given skilled surgeons the tools in order to fix urine leakage with simple thirty minute outpatient procedures that leave no visible scars. It is a readily treatable condition with minimal side effects or long-term risks.

Empowering women with clinical knowledge is rewarding. That is my suspender-snapping moment.

If you have issues with urinary incontinence, help is available. Call us today to schedule an appointment at 770.720.7733 or schedule an appointment online.

Dr. Gandhi authored this article and is a board-certified urogynecologist with Cherokee Women’s Health Specialists in Canton and Woodstock. Urogynecology is a subspecialty within Obstetrics and Gynecology that focuses on disorders of the female pelvic floor such as pelvic organ prolapse (bulging out of the uterus and/or vagina), urinary incontinence, fecal incontinence and constipation.

October 7, 2014

rollercoaster-picI love the twists, turns and rapid descents of roller coasters. Do you remember the first roller coaster you ever rode? Nope, it wasn’t at Six Flags or some other awesomely fun amusement park. It was while you were maneuvering through the birth canal. That’s right, the process of being born is very much like riding a roller coaster.

Cardinal Movements

The journey an infant takes and the adaptations made while being born is referred to as the cardinal movements. The first cardinal movement is called descent. Just as you feel when your stomach drops as the roller coaster rushes down full speed, down into the valley, securely positioned into your seat by the tight lap bar, an infant’s head is pushed deep into the pelvis.

Flexion

Next is flexion. Do you remember trying to raise your head in the coaster while diving into the valley at high speed? This is similar to an infant’s chin that’s secured onto the breast bone as they prepare for the tight fit. Just as you can’t raise your head, neither can a baby.

Engagement

Engagement is next. This is the moment you catch your breath before the next thrill, the next turn.
This is when an infant’s head reaches the pelvic inlet. The infant now undergoes a sharp internal rotation, sometimes at a 90 degree angle, in order to accommodate your pelvis. And just as the coaster comes out of its last turn, the infant extends its head, only to take one last turn before applying the brakes.

External Rotation

Next is external rotation. This is the this final turn that allows for the infant to line its head up to its back to allow for the final step, which is expulsion. And finally, the screams. All at once, the cries of excitement and relief converge.

Season Passes

Just as you might have a season pass for an amusement park, some women open up admission to allow for riders every season! Two, three, four or more deliveries later, these season passes can take a toll on a woman’s equipment.

Can you imagine the CEO of Six Flags complaining because they’ve sold too many tickets for the roller coasters and are now making too much money? Well that’s kind of how women view it when they come to see me about pelvic complaints. After all, what right do they have to complain about the wear and tear on their equipment when the birth of a child makes them so rich with love and blessings?

We Are Human

It’s this very notion that I try to absolve. Urinary incontinence, pelvic organ prolapse, and suffering obstetric lacerations are not a rite of passage. It simply reveals how vulnerable our bodies are to trauma. It simply makes us human. Thankfully, our ability to repair our bodies makes us sustainable.

The miracle of birth does not need to be altered but the recovery can be optimized. When I see a woman and discuss these very personal issues, I keep in mind this notion she came with and value her beauty as a mother. I also try to reassure her and offer solutions to restore her beauty as a woman as well. After all, being a woman and a mother are two of the most beautiful things on this planet and they deserve to be treasured.

-Dr. Peahen Gandhi

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